Grade Report Request

Office of Registration and Records University of Wisconsin - Stout

2008 Summer

Final Grade Report Request Form

There is no charge for an official grade report. A stamped, self-addressed envelope is required for each semester/term requested. Only one request per envelope will be processed. Failure to complete this entire form may result in a delay in the issuance of your grade report.

Due to the Family Rights and Privacy Act of 1974, your signature is required for the release of a grade report. Be sure to sign this form after printing it.

Please fill out this entire form. Print, sign and mail this form along with a stamped, self-addressed envelope to:

Registration and Records
109 Bowman Hall

Menomonie, WI 54751

First Name:

Last Name:

Initial:

UW Stout ID Number:

Date of Birth:

Address to send Grade Report to :

Stout E-mail Address:

Daytime Phone #:

I hereby give consent to have my grade report released.
Signature:

Failure to complete this entire form and/or submission of envelope may result in a delay in the issuance of your grade report.